Disorders - Psychosis Disorders
Li, H., Kong, L., Shen, Q., Zhang, C., Liang, G., Zuo, X., Wang, C., Li, B., Sun, X., Wang, H., Zhu, X.
Objectives: To evaluate the cognitive
improvement and assess the practice effects on patients with first-episode schizophrenia (FES) after accepting second-generation antipsychotic
medications (SGAs): olanzapine and risperidone. Methods: A total of 98 patients with a diagnosis of schizophrenia and 63 healthy controls were
randomly recruited in this study from Xuzhou East Hospital affiliated to Xuzhou Medical University and Qingdao mental health center and divided into
3 groups (olanzapine, risperidone and healthy controls). The cognitive assessment and the neurocognitive detection would be taken for all groups and
compared when appeared at baseline, six weeks later, and sixteen weeks later. The neurocognitive detections were inclusive of measurements of working
memory and attention, speed, motor function, episodic memory, and executive function. Results: There was no significant different drug effect on
cognitive performance between olanzapine and risperidone groups (P>0.05). The cognitive performance of both groups was improved. However, all
cognitive evaluations for FES patients were obviously below those of HCs group (P<0.05). Besides, drug effects were bigger than practice effects in
the cognitive tests in our study (P<0.005). Conclusion: To some extent, some cognitive improvements for the FES group may due to practice effects.
However, differential medication effects on cognition were tiny in terms of our results in this study. Copyright © 2017, E-Century Publishing
Corporation. All rights reserved.
International Journal of Clinical and Experimental Medicine, 10(2) : 3600-
3605
- Year: 2017
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Malla, A., Joober, R., Iyer, S., Norman, R., Schmitz, N., Brown, T., Lutgens, D., Jarvis, E., Margolese, H. C., Casacalenda, N., Abdel-Baki, A., Latimer, E., Mustafa, S., Abadi, S.
This study aimed to determine if, following two years of early intervention service for first-episode psychosis, three-year
extension of that service was superior to three years of regular care. We conducted a randomized single blind clinical trial using an urn
randomization balanced for gender and substance abuse. Participants were recruited from early intervention service clinics in Montreal. Patients
(N=220), 18-35 years old, were randomized to an extension of early intervention service (EEIS; N=110) or to regular care (N=110). EEIS included case
management, family intervention, cognitive behaviour therapy and crisis intervention, while regular care involved transfer to primary (community
health and social services and family physicians) or secondary care (psychiatric outpatient clinics). Cumulative length of positive and negative
symptom remission was the primary outcome measure. EEIS patients had a significantly longer mean length of remission of positive symptoms (92.5 vs.
63.6 weeks, t=4.47, p<0.001), negative symptoms (73.4 vs. 59.6 weeks, t=2.84, p=0.005) and both positive and negative symptoms (66.5 vs. 56.7 weeks,
t=2.25, p=0.03) compared to regular care patients. EEIS patients stayed in treatment longer than regular care patients (mean 131.7 vs. 105.3 weeks,
t=3.98, p<0.001 through contact with physicians; 134.8 +/- 37.7 vs. 89.8 +/- 55.2, t=6.45, p<0.0001 through contact with other health care providers)
and received more units of treatment (mean 74.9 vs. 39.9, t=4.21, p<0.001 from physicians, and 57.3 vs. 28.2, t=4.08, p<0.001 from other health care
professionals). Length of treatment had an independent effect on the length of remission of positive symptoms (t=2.62, p=0.009), while number of
units of treatment by any health care provider had an effect on length of remission of negative symptoms (t=-2.70, p=0.008) as well as total symptoms
(t=-2.40, p=0.02). Post-hoc analysis showed that patients randomized to primary care, based on their better clinical profile at randomization,
maintained their better outcome, especially as to remission of negative symptoms, at the end of the study. These data suggest that extending early
intervention service for three additional years has a positive impact on length of remission of positive and negative symptoms compared to regular
care. This may have policy implications for extending early intervention services beyond the current two years. Copyright © 2017 World Psychiatric
Association
World Psychiatry, 16(3) : 278-
286
- Year: 2017
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Atypical Antipsychotics (second
generation), Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Family therapy, Case management, Other service delivery and improvement
interventions
McEwen, S., Jarrahi, B., Subotnik, K., Ventura,
J., Nuechterlein, K.
Background: Schizophrenia patients
experience debilitating cognitive dysfunctions that serve as a barrier in their returning to full work or social functioning. Current pharmacologic
treatments in Schizophrenia have limited success in remediating cognitive deficits. Both aerobic exercise and cognitive training separately have been
found to increase neuroplasticity and improve cognitive functioning to a moderate degree in Schizophrenia. This is the first study to examine the
effects of a combined exercise and cognitive training intervention on brain plasticity in first-episode Schizophrenia patients. Methods: MRI scans
were collected at UCLA to extrapolate cortical thickness and resting-state fMRI measurements at baseline and 6-month follow-up in 37 first-episode
Schizophrenia patients randomly assigned to combined cognitive training and exercise (CT&E, N520) or cognitive training without exercise (CT, N517)
for 6 months. The MCCB cognitive battery was also administered at baseline and 6 months. Results: Significant Group x Time interactions for cortical
thickness were found in prefrontal regions (left DLPFC, superior frontal gyrus and right medial orbitofrontal cortices). The CT&E group showed
improved functional connectivity, compared to the CT group, between the right central executive network (CEN) and the ventral attention network and
also between the left CEN and right CEN. Improved functional connectivity between the left and right CEN was associated with cognitive gains in
Reasoning and Problem Solving at 6-month follow-up. Conclusions: These structural and functional connectivity findings highlight the additive role of
exercise to bolster increases in cortical thickness and lead to more efficient functional organization in the PFC, which was related to improvements
in executive functioning.
Biological Psychiatry, 81(10 (Suppl
1)) : S161
- Year: 2017
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Psychological Interventions
(any), Cognitive remediation
therapy, Physical activity, exercise
McGorry, P. D., Nelson, B., Markulev,
C., Yuen, H. P., Schafer, M. R., Mossaheb, N., Schlogelhofer, M., Smesny, S., Hickie, I. B., Berger, G. E., Chen, E. Y., de-Haan, L., Nieman, D. H., Nordentoft, M., Riecher-
Rossler, A., Verma, S., Thompson, A., Yung, A. R., Amminger, G.
Importance: A promising treatment
to prevent onset and improve outcomes in patients at ultrahigh risk for psychosis is dietary supplementation with long-chain omega-3 polyunsaturated
fatty acids (PUFAs). Objective: To determine whether treatment with omega-3 PUFAs in combination with a high-quality psychosocial intervention
(cognitive behavioral case management [CBCM]) is more effective than placebo plus CBCM. Design, Setting, and Participants: NEURAPRO, a double-blind,
placebo-controlled, randomized clinical trial, was conducted from March 1, 2010, to September 30, 2014, in 10 specialized early psychosis treatment
services in Australia, Asia, and Europe. The primary analysis used the intention-to-treat approach. Interventions: A daily dose of 1.4 g of omega-3
PUFAs or placebo (paraffin oil), plus 20 or fewer sessions of CBCM over the 6-month study period. Main Outcomes and Measures: The primary outcome was
transition to psychosis status at 6 months. The secondary outcomes were general levels of psychopathology and functioning, as assessed by the Brief
Psychiatric Rating Scale (BPRS) (range, 24-168), Scale for the Assessment of Negative Symptoms (SANS) (range, 0-125), Montgomery-Asberg Depression
Rating Scale (MADRS) (range, 0-60), Young Mania Rating Scale (YMRS) (range, 0-44), Social and Occupational Functioning Assessment Scale (SOFAS)
(range, 0-100), and the Global Functioning: Social and Role scale (range, 0-10). For SOFAS and Global Functioning: Social and Role scale, higher
scores were better; for other measures, lower scores were better. Results: In this study of 304 adults at ultrahigh risk for psychotic disorders, 153
(50.3%) received omega-3 PUFAs and 151 (49.7%) received placebo. In all, 139 (45.7%)were male; mean (SD) agewas 19.1 (4.6) years. The Kaplan-Meier-
estimated 6-month transition rates were 5.1% (95%CI, 1.3%- 8.7%) in the control group and 6.7%(95% CI, 2.3%-10.8%) in the omega-3 PUFA group. At 12
months, the rates were 11.2%(95%CI, 5.5%-16.7%) in the control group and 11.5%(95%CI, 5.8%-16.9%) in the omega-3 PUFA group. No significant
difference was observed between the transition rates of both groups (hazard ratio, 1.1; 95%CI, 0.55-2.23; P = .76, stratified log-rank test).
Conclusions and Relevance: This trial clearly failed to replicate the findings of the original single-center trial. The most likely explanation is
that omega-3 PUFAs lack efficacy under these conditions. However, the lower-than-expected transition rate may have prevented a test of the main
hypothesis. Given the substantial symptomatic and functional improvement in both groups, the other treatments received (ie, CBCM and antidepressants)
likely produced a ceiling effect beyond which omega-3 PUFAs, even if effective, could not be shown to confer additional benefits. Nevertheless, the
main conclusion is that omega-3 PUFAs are not effective under conditions where good quality, evidence-based psychosocial treatment is available.
(PsycINFO Database Record (c) 2017 APA, all rights reserved)
JAMA Psychiatry, 74(1) : 19-
27
- Year: 2017
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Fish oil (Omega-3 fatty acids), Omega 3 fatty
acids (e.g. fish oil, flax oil), Case management
Krause, M., Zhu, Y., Schneider-Thoma, J., Huhn, M., Salanti, G., Chaimani, A., Leucht, S.
Introduction: Children and
adolescents with schizophrenia are a particulary vulnerable group. On the one hand, an early onset can be a sign of a less favourable prognosis,
therefore it may be important to reach for the maximum efficacy at this stage. On the other hand, children and adolescents are even more sensitive to
the side-effects of antipsychotics, and hormone related adverse events maybe particularly problematic. Therefore, when using antipsy chotics in this
population efficacy and side-effects must be carefully weighted [1]. Aims: We therefore attempted to integrate all the randomized evidence from the
available antipsychotics used for schizophrenic children and adolescents by performing a network meta-analysis. Methods: As data sources we searched
MEDLINE, EMBASE, PsycINFO, Cochrane Library, PubMed, Biosis, and ClinicalTrials. gov up to Nov 17, 2016. At least 2 independent reviewers selected
published and unpublished single-and double-blind RCTs children and adolescents with schizophrenia (any study-defined criterion) that compared any
antipsychotic (at any dose and in any oral form of administration) with another antipsychotic or placebo. At least 2 independent reviewers extracted
all data into standard forms and assessed the quality of all included trials with the Cochrane Collaboration's risk-of-bias tool. Data were pooled
using a random-effects model in a frequentist setting. The primary outcome was efficacy as measured by overall Change/endpoint in symptoms of
schizophrenia. Secondary outcomes included change in positive and negative symptoms of schizophrenia, categorical response to treatment, dropouts for
any reason and for inefficacy of treatment, measures of quality of life and social functioning or important side effects like weight gain, sedation,
prolactin increase, EPS and use of antiparkinsonian medication. Results: Twenty seven unique open and blinded RCTs with 2328 unique participants (62%
men; mean age 14.35 years). published from 1967 to March 2015 were identified through the literature search. Few significant differences were found
in all outcomes. In the primary outcome clozapine was significantly more effective than all others analyzed antipsychotics except olanzapine. For
olanzapine there was just a significant better efficacy compared to olanzapine. Nearly all antipsychotics were more efficacious compared to placebo.
In terms of preventing weight gain, molindone and ziprasidone were better as placebo. The highest weight gain was found for clozapine and olanzapine.
Conclusions: In summary we can say that there is a gap of evidence for some drugs and a lot of outcomes, especially safety outcomes. Most of the
comparisons are based only on one study or just on indirect evidence. Never the less the available direct and indirect evidence showed that the
treatment effects were very similar compared to the results in our previous meta-analyses on adult people with schizophrenia [2], [3]. The evidence
in this area is rapidly growing making it important to keep these systematic reviews up to date.
European Neuropsychopharmacology, 27(Suppl
4) : S948
- Year: 2017
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only), Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation)
Lutgens, D., Gariepy, G., Malla, A.
Background: Negative symptoms observed in patients with psychotic disorders undermine quality of life and functioning.
Antipsychotic medications have a limited impact. Psychological and psychosocial interventions, with medication, are recommended. However, evidence
for the effectiveness of specific non-biological interventions warrants detailed examination. Aims: To conduct a meta-analytic and systematic review
of the literature on the effectiveness of non-biological treatments for negative symptoms in psychotic disorders. Method: We searched for randomised
controlled studies of psychological and psychosocial interventions in psychotic disorders that reported outcome on negative symptoms. Standardised
mean differences (SMDs) in values of negative symptoms at the end of treatment were calculated across study domains as the main outcome measure.
Results: A total of 95 studies met our criteria and 72 had complete quantitative data. Compared with treatment as usual cognitive-behavioural therapy
(pooled SMD 70.34, 95% CI 70.55 to 70.12), skills-based training (pooled SMD 70.44, 95% CI 70.77 to 70.10), exercise (pooled SMD 70.36, 95% CI 70.71
to 70.01), and music treatments (pooled SMD 70.58, 95% CI 70.82 to 70.33) provide significant benefit. Integrated treatment models are effective for
early psychosis (SMD 70.38, 95% CI 70.53 to 70.22) as long as the patients remain in treatment. Overall quality of evidence was moderate with a high
level of heterogeneity. Conclusions: Specific psychological and psychosocial interventions have utility in ameliorating negative symptoms in
psychosis and should be included in the treatment of negative symptoms. However, more effective treatments for negative symptoms need to be
developed. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
British Journal of Psychiatry, 210(5) : 324-
332
- Year: 2017
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder), First episode (psychosis only)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Cognitive remediation
therapy, Family therapy, Skills training, Creative expression: music, dance, drama, art, Physical activity, exercise, Other service delivery and improvement
interventions
Zheng, W., Cai, D., Yang, X., Ungvari, G., Ng, C., Muller, N., Ning, Y., Xiang, Y.
Neuroinflammation has been implicated in the
neurobiological pathways of schizophrenia. This meta-analysis evaluated the efficacy and tolerability of adjunctive celecoxib as a noncompetitive
anti-inflammation drug in treating schizophrenia. Data were searched, extracted, checked and entered into the RevMan (version 5.3) software by two
independent investigators. Standardized/weighted mean differences (SMDs/WMDs), risk ratio (RR) and their 95% confidence intervals (CIs) were
calculated, as appropriate. Included were 8 randomized controlled trials (RCTs) with a total of 626 patients with schizophrenia including 316 (50.5%)
treated on celecoxib (400 mg/day) and 310 (49.5%) on placebo over 8.3 +/- 2.3 weeks of treatment. Adjunctive celecoxib outperformed placebo with
respect to total psychopathology [3 RCTs, n = 180; SMD: -0.47; 95%CI: -0.81, -0.14; P = 0.005; I2 = 18%; 'moderate quality'], symptoms positive [3
RCTs, n = 180; SMD: -0.50; 95%CI: -0.79, -0.20; P = 0.001; I2 = 0%; 'moderate quality'], negative symptoms [3 RCTs, n = 180; SMD: -0.32; 95%CI: -
0.66, 0.02; P = 0.06; I2 = 22%; 'moderate quality'], and general psychopathology scores [3 RCTs, n = 180; SMD: -0.35; 95%CI: -0.65, -0.06; P =
0.02; I2 = 0%; 'moderate quality'] in first-episode, but not chronic patients. Additionally, superiority of celecoxib for the Positive and Negative
Syndrome Scale (PANSS) total scores was moderated by higher PANSS positive scores and lower PANSS negative scores at baseline. All-cause
discontinuation [RR: 1.02; (95%CI: 0.56, 1.86); P = 0.94; I2 = 0%] and adverse drug reactions were similar between the two groups. Adjunctive
celecoxib appears to be an efficacious and safe treatment in improving psychotic symptoms, particularly in first-episode schizophrenia. (PsycINFO
Database Record (c) 2017 APA, all rights reserved)
Journal
of Psychiatric Research, 92 : 139-146
- Year: 2017
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only), Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions
Zhu, Y., Krause, M., Huhn, M., Rothe, P., Schneider-Thoma, J., Chaimani, A., Li, C., Davis, J., Leucht,
S.
Background: The first episode of schizophrenia is a pivotal phase of this debilitating illness. Which drug to use remains
controversial without a summary of all direct or indirect comparisons of drugs. We did a systematic review with pairwise and network meta-analyses of
efficacy and tolerability. Methods: We searched MEDLINE, Embase, PsycINFO, Cochrane Library, PubMed, Biosis, and ClinicalTrials.gov for randomised
controlled trials of antipsychotics for the acute treatment of first-episode schizophrenia, published up to Nov 17, 2016. Our primary outcome was
overall change in symptoms. Secondary outcomes were change in positive and negative symptoms, categorical response to treatment, study dropout for
any reason and for inefficacy of treatment, use of drugs to treat parkinsonian symptoms, weight gain, sedation, increase in prolactin release,
overall functioning, and quality of life. We did the meta-analyses with a random-effects model to calculate standardised mean differences (SMDs) or
odds ratios (ORs) with 95% CIs. Findings: We identified 19 relevant randomised controlled trials of 12 antipsychotic drugs that involved 2669
participants. 13 of the studies presented data on the primary outcome. For overall reduction of symptoms, amisulpride (SMD -0.37, 95% CI -0.61 to -
0.14), olanzapine (-0.25, -0.39 to -0.12), ziprasidone (-0.25, -0.48 to -0.01), and risperidone (-0.14, -0.27 to -0.01) were significantly more
efficacious than haloperidol, but the evidence was very low to moderate quality. Amisulpride was superior for reduction of symptoms to quetiapine
(SMD -0.25, 95% CI -0.50 to -0.01). Olanzapine was superior to haloperidol and risperidone for reduction of negative symptoms. Several second-
generation antipsychotics were superior to haloperidol in terms of all-cause discontinuation. Olanzapine was associated with at least one use of
drugs to treat parkinsonian symptoms and quetiapine with less akathisia than haloperidol, aripiprazole, risperidone, and olanzapine, but, again,
evidence was very low to low quality. Molindone was superior to risperidone, haloperidol, and olanzapine in terms of weight gain, and superior to
risperidone in terms of increase in prolactin release. Interpreation: Haloperidol seems to be a suboptimum treatment option for acute treatment of
first-episode schizophrenia, but we found little difference between second-generation antipsychotics. The evidence was generally of low quality and
the numbers of patients for each drug were small. Thus, the choice of treatment should be guided primarily by side-effects. (PsycINFO Database Record
(c) 2017 APA, all rights reserved)
Lancet Psychiatry, 4(9) : 694-
705
- Year: 2017
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation)
Zhu, Y., Li, C., Huhn, M., Rothe, P., Krause, M., Bighelli, I., Schneider-Thoma, J., Leucht, S.
It is often stated that first-episode patients tend to respond better to antipsychotics than
chronic patients, but the exact numbers and moderators of response in this population are unclear. We, therefore, present the first systematic review
on response rates of first episode patients with schizophrenia in randomized trials. We searched multiple databases for randomized-controlled trials
of antipsychotics in acutely ill patients with a first episode of schizophrenia (last search: November 17, 2016). The outcomes were response rate
based on two criteria, at least 50% PANSS or BPRS total score reduction from baseline and at least 20% reduction. Data were pooled in a single-group
summary meta-analysis using Comprehensive Meta-Analysis software. Moreover, several potential moderators of response to antipsychotics were examined
by meta-regression. We included 17 studies with a total of 3156 participants. On the average, 81.3%/51.9% of the first-episode patients reached an at
least 20%/50% PANSS or BPRS reduction from baseline, respectively. Meta-regressions revealed a better treatment response in female patients, in more
severely ill patients at baseline, in antipsychotic naive patients, in patients with a shorter illness duration and in open studies. Study duration
and dosage were no significant moderators of response. Our finding suggest that more than 80% of first-episode patients achieved 20% PANSS/BPRS
reduction from baseline and around 50% achieved a 50% PANSS/BPRS reduction. Several patient characteristics moderated response rates. (PsycINFO
Database Record (c) 2017 APA, all rights reserved)
European Neuropsychopharmacology, 27(9) : 835-
844
- Year: 2017
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation)
Ochoa, S., Lopez-Carrilero,
R., Barrigon, M., Pousa, E., Barajas, A., Lorente-Rovira, E., Gonzalez-Higueras, F., Grasa, E., Ruiz-Delgado, I., Cid, J., Birules,
I., Esteban-Pinos, I., Casanas, R., Luengo, A., Torres-Hernandez, P., Corripio, I., Montes-Gamez, M., Beltran, M., De-Apraiz, A., Dominguez-
Sanchez, L., Sanchez, E., Llacer, B., Pelaez,
T., Bogas, J., Moritz, S.
Background: Aims were to assess the efficacy of metacognitive training (MCT) in people with a recent onset of psychosis
in terms of symptoms as a primary outcome and metacognitive variables as a secondary outcome. Method: A multicenter, randomized, controlled clinical
trial was performed. A total of 126 patients were randomized to an MCT or a psycho-educational intervention with cognitive-behavioral elements. The
sample was composed of people with a recent onset of psychosis, recruited from nine public centers in Spain. The treatment consisted of eight weekly
sessions for both groups. Patients were assessed at three time-points: baseline, post-treatment, and at 6 months follow-up. The evaluator was blinded
to the condition of the patient. Symptoms were assessed with the PANSS and metacognition was assessed with a battery of questionnaires of cognitive
biases and social cognition. Results: Both MCT and psycho-educational groups had improved symptoms post-treatment and at follow-up, with greater
improvements in the MCT group. The MCT group was superior to the psycho-educational group on the Beck Cognitive Insight Scale (BCIS) total (p =
0.026) and self-certainty (p = 0.035) and dependence self-subscale of irrational beliefs, comparing baseline and post-treatment. Moreover, comparing
baseline and follow-up, the MCT group was better than the psycho-educational group in self-reflectiveness on the BCIS (p = 0.047), total BCIS (p =
0.045), and intolerance to frustration (p = 0.014). Jumping to Conclusions: (JTC) improved more in the MCT group than the psycho-educational group (p
= 0.021). Regarding the comparison within each group, Theory of Mind (ToM), Personalizing Bias, and other subscales of irrational beliefs improved in
the MCT group but not the psycho-educational group (p < 0.001-0.032). Conclusions MCT could be an effective psychological intervention for people
with recent onset of psychosis in order to improve cognitive insight, JTC, and tolerance to frustration. It seems that MCT could be useful to improve
symptoms, ToM, and personalizing bias. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Psychological Medicine, 47(9) : 1573-1584
- Year: 2017
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Psychoeducation, Other Psychological Interventions
Pagsberg, A. K., Jeppesen, P., Klauber, D. G., Jensen, J. G., Ruda,
D., Stentebjerg-Olesen, M., Jantzen,
P., Rasmussen, S., Saldeen, E. A-S., Lauritsen, M-B. G., Bilenberg, N., Stenstrom, A. D., Nyvang, L., Madsen, S., Werge, T. M., Lange, T., Gluud, C., Skoog, M., Winkel, P., Jepsen, J. R. M., Fagerlund, B., Correll, C. U., Fink-Jensen, A.
Background
Head-to-head trials to guide antipsychotic treatment choices for paediatric psychosis are urgently needed because extrapolations from adult studies
might not be implementable. In this superiority trial with two-sided significance testing, we aimed to compare the efficacy and safety of
quetiapine-extended release (quetiapine-ER) versus aripiprazole in children and adolescents with first-episode psychosis, to determine whether
differences between the two treatments were sufficient to guide clinicians in their choice of one drug over the other. Methods In this multicentre,
double-blind, randomised trial in seven Danish university clinics, we recruited children and adolescents aged 12-17 years with a diagnosis of ICD-10
schizophrenia-spectrum disorder, delusional disorder, or affective-spectrum psychotic disorder, and psychotic symptoms scoring at least 4 on at least
one of the following Positive and Negative Syndrome Scale (PANSS) items: P1 (delusions), P2 (conceptual disorganisation), P3 (hallucinations), P5
(grandiosity), P6 (suspiciousness/persecution), and G9 (unusual thought content), and a total PANSS score greater than 60. Patients were randomly
assigned (1:1) to 12 weeks of treatment with target doses of 600 mg/day of quetiapine-ER (starting from 50 mg/day) or 20 mg/day of aripiprazole
(starting from 2.5 mg/day). The assigned drug was titrated over five levels, with 2 days at each dose, and the final dose achieved on day 9.
Randomisation was done using a computer-generated concealed sequence with a block size of 8, and stratified by baseline PANSS positive score (<=20
points or >20 points) and age (12-14 years or 15-17 years). Study drugs were administered in identical capsules, and interventions, assessments, and
data analysis were done masked. The primary outcome was PANSS positive score. Key adverse outcomes were bodyweight, homoeostatic model of insulin
resistance (HOMA-IR), akathisia, and sedation. Analyses were by intention to treat. This study is registered with ClinicalTrials.gov, number
NCT01119014. Findings Between June 10, 2010, and Jan 29, 2014, 231 participants were assessed for elegibility, of whom 113 were randomly assigned to
quetiapine-ER (n=55) or aripiprazole (n=58). PANSS positive score did not differ between groups after 12 weeks (adjusted mean change -5.05 [5.46] for
quetiapine-ER, -6.21 [5.42] for aripiprazole; p=0.98), but decreased over time in both groups (p<0.0001). Weight gain was more rapid with
quetiapine-ER (p=0.0008), with an adjusted mean weight group difference at week 12 of 3.33 kg (SD 7.23; effect size 0.64; p<0.0001). The HOMA-IR
group difference at week 12 favoured aripiprazole (adjusted mean log-transformed group difference 0.259 [SD 0.906]; effect size 0.35; p=0.0060).
Akathisia was more common with aripiprazole at week 2 (observed in 34 [60%] of 57 patients; estimated 63.5%) than with quetiapine-ER (15 [30%] of 50;
estimated 31.3%; p=0.0021), but not at other timepoints. Sedation proportions did not change significantly over time with either intervention
(observed at weeks 2, 4, and 12, respectively, for quetiapine-ER in 43 [83%] of 52, 40 [83%] of 48, and 34 [72%] of 47 patients and for aripiprazole
in 49 [89%] of 55, 52 [96%] of 54, and 44 [92%] of 48 patients), and the overall estimated probability combining all timepoints was significantly
higher for aripiprazole (97.1%) than for quetiapine-ER (89.2%; p=0.012). In addition to sedation and akathisia, the most common adverse events were
tremor, increased duration of sleep, orthostatic dizziness, depression, tension/inner unrest, failing memory, and weight gain. (PsycINFO Database
Record (c) 2017 APA, all rights reserved)
Lancet Psychiatry, 4(8) : 605-
618
- Year: 2017
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder), First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Pos, K., Meijer, C. J., Verkerk, O., Ackema, O., Krabbendam, L., de-Haan, L.
Cognitive biases, negative affect and negative self-
esteem are associated with paranoia in people with psychotic disorders. Metacognitive group training (MCT) aims to target these biases although
research has shown mixed results. Our objective was to establish the effect of MCT on paranoid ideation in patients with recent onset psychosis in a
powerful experience sampling design. 50 patients between the age of 18 and 35 were included in a single-blind, parallel group RCT comparing MCT with
occupational therapy (OT) as an active control condition. We assessed via questionnaires and experience sampling treatment effects on paranoid
ideation, delusional conviction, the cognitive bias jumping to conclusion (JTC), and cognitive insight, as well as treatment effects on associations
between negative affect, negative self-esteem and paranoid ideation. Patients in the MCT group did not show a decrease in paranoid ideation,
delusional conviction, JTC-bias or an increase in cognitive insight compared with OT. However, negative affect showed a weaker association with
paranoid ideation post-treatment in the MCT condition. In the OT condition, this association was stronger post-treatment. We tentatively suggest that
patients with an early psychosis seemed to benefit from MCT in emotional learning compared with the OT condition. Despite the fact that the group
training is well-received by patients, subsequent individual MCT (MCT+) may be indicated for stronger favorable effects on paranoid ideation.
Copyright © 2017 The Author(s)
European Archives of Psychiatry and Clinical Neuroscience, 268 : 57-
64
- Year: 2017
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
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Stage: First episode (psychosis only)
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Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other Psychological Interventions